{"id":2229,"date":"2024-12-06T12:10:32","date_gmt":"2024-12-06T12:10:32","guid":{"rendered":"https:\/\/medibillmd.com\/blog\/?p=2229"},"modified":"2024-12-06T12:11:37","modified_gmt":"2024-12-06T12:11:37","slug":"cpt-code-97750","status":"publish","type":"post","link":"https:\/\/medibillmd.com\/blog\/cpt-code-97750\/","title":{"rendered":"CPT Code 97750 for Functional Capacity Evaluation (FCE)"},"content":{"rendered":"\n<p>Just another day, just another code to demystify! Such is the life when it comes to medical billing. But with us by your side, perplexity is transformed into mastery as we unlock the wonders of medical billing, code by code.&nbsp;<\/p>\n\n\n\n<p>It is time to explore the depths of CPT code 97750, which has rightly become a coding conundrum across several medical specialties. Stay with us as we tell you why 97750 is often called the FCE CPT code and when and how to bill it for maximum reimbursement.&nbsp;<\/p>\n\n\n\t\t\t\t<div class=\"wp-block-uagb-table-of-contents uagb-toc__align-left uagb-toc__columns-1 uagb-toc__collapse uagb-block-a4a4c1fc      \"\n\t\t\t\t\tdata-scroll= \"1\"\n\t\t\t\t\tdata-offset= \"30\"\n\t\t\t\t\tstyle=\"\"\n\t\t\t\t>\n\t\t\t\t<div class=\"uagb-toc__wrap\">\n\t\t\t\t\t\t<div class=\"uagb-toc__title\">\n\t\t\t\t\t\t\tTable Of Contents\t\t\t\t\t\t\t\t\t\t\t\t\t<svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox= \"0 0 384 512\"><path d=\"M192 384c-8.188 0-16.38-3.125-22.62-9.375l-160-160c-12.5-12.5-12.5-32.75 0-45.25s32.75-12.5 45.25 0L192 306.8l137.4-137.4c12.5-12.5 32.75-12.5 45.25 0s12.5 32.75 0 45.25l-160 160C208.4 380.9 200.2 384 192 384z\"><\/path><\/svg>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"uagb-toc__list-wrap \">\n\t\t\t\t\t\t<ol class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#97750-cpt-code-description\" class=\"uagb-toc-link__trigger\">97750 CPT Code &#8211; Description<\/a><ul class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#what-performance-measurement-tests-are-covered-by-cpt-code-97750\" class=\"uagb-toc-link__trigger\">What Performance Measurement Tests are Covered By CPT Code 97750?\u00a0\u00a0<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#what-should-you-expect-during-a-functional-capacity-evaluation-session\" class=\"uagb-toc-link__trigger\">What Should You Expect During a Functional Capacity Evaluation Session?<\/a><\/li><\/ul><\/li><li class=\"uagb-toc__list\"><a href=\"#scenarios-where-cpt-code-97750-is-applicable\" class=\"uagb-toc-link__trigger\">Scenarios Where CPT Code 97750 is Applicable<\/a><ul class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#pre-employment-screening\" class=\"uagb-toc-link__trigger\">Pre-Employment Screening<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#workers-compensation-cases\" class=\"uagb-toc-link__trigger\">Workers\u2019 Compensation Cases<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#disability-assessments\" class=\"uagb-toc-link__trigger\">Disability Assessments\u00a0<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#rehabilitation-progress-evaluation\" class=\"uagb-toc-link__trigger\">Rehabilitation Progress Evaluation\u00a0<\/a><\/li><\/ul><\/li><\/ul><\/li><li class=\"uagb-toc__list\"><a href=\"#other-cpt-codes-related-to-97750\" class=\"uagb-toc-link__trigger\">Other CPT Codes Related to 97750<\/a><ul class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#cpt-code-95851\" class=\"uagb-toc-link__trigger\">CPT Code 95851<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#cpt-code-95852\" class=\"uagb-toc-link__trigger\">CPT Code 95852<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#cpt-code-97755\" class=\"uagb-toc-link__trigger\">CPT Code 97755<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#cpt-code-96112\" class=\"uagb-toc-link__trigger\">CPT Code 96112<\/a><\/li><\/ul><\/li><\/ul><\/li><\/ul><\/li><li class=\"uagb-toc__list\"><a href=\"#97750-cpt-code-reimbursement-guidelines\" class=\"uagb-toc-link__trigger\">97750 CPT Code &#8211; Reimbursement Guidelines<\/a><ul class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#ensure-coding-accuracy\" class=\"uagb-toc-link__trigger\">Ensure Coding Accuracy\u00a0<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#maintain-complete-documentation\" class=\"uagb-toc-link__trigger\">Maintain Complete Documentation<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#educate-and-train-your-staff\" class=\"uagb-toc-link__trigger\">Educate and Train Your Staff\u00a0<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#confirm-direct-provider-patient-contact\" class=\"uagb-toc-link__trigger\">Confirm Direct Provider-Patient Contact\u00a0<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#bill-in-15-minute-increments\" class=\"uagb-toc-link__trigger\">Bill in 15-Minute Increments\u00a0<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#follow-cms-8-minute-rule\" class=\"uagb-toc-link__trigger\">Follow CMS\u2019 8-Minute Rule\u00a0<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#dont-bill-97750-cpt-code-on-the-same-day-as-an-initial-evaluation\" class=\"uagb-toc-link__trigger\">Don\u2019t Bill 97750 CPT Code On the Same Day as An Initial Evaluation<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#append-appropriate-physical-therapy-modifiers\" class=\"uagb-toc-link__trigger\">Append Appropriate Physical Therapy Modifiers\u00a0<\/a><\/li><\/ul><\/li><\/ul><\/li><\/ul><\/li><\/ul><\/li><li class=\"uagb-toc__list\"><a href=\"#final-word\" class=\"uagb-toc-link__trigger\">Final Word\u00a0<\/a><\/ul><\/ul><\/ul><\/ul><\/ol>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\n\n\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>97750 CPT Code &#8211; Description<\/strong><\/h2>\n\n\n\n<p>The current procedural terminology (CPT) code 97750 reports a physical performance test, such as musculoskeletal and functional capacity evaluation (FCE), for patients who suffered work-related injuries, physical traumas, or disabilities and might be in the process of rehabilitation or post-surgery care. For this reason, it is also known as a FCE CPT code.<\/p>\n\n\n\n<p>You can find the 97750 code specifically in the Physical Medicine and Rehabilitation Tests and Measurements code set, as maintained by the <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">American Medical Association<\/a> (AMA).\u00a0<\/p>\n\n\n\n<p>CPT code 97750 is used when the provider evaluates the patient\u2019s physical performance in 15-minute increments and records the results to prepare a comprehensive report, which may then be used to determine if the patient is fit to resume work after an illness or injury.&nbsp;&nbsp;<\/p>\n\n\n\n<p>In the case of Functional Capacity Evaluation CPT Code 97750, the series of tests and measurements must target the patient\u2019s ability to perform activities of daily living (ADLs) or instrumental activities of daily living (IADLs), both of which are crucial to a human\u2019s normal functioning and readiness for work.&nbsp;<\/p>\n\n\n\n<p><strong>Medical specialties that are more inclined to report<\/strong><strong> FCE CPT code 97750<\/strong><strong> are:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Physical Therapy\u00a0<\/li>\n\n\n\n<li>Physical Medicine &amp; Rehabilitation (PM&amp;R) or Physiatry<\/li>\n\n\n\n<li>Occupational Therapy\u00a0<\/li>\n\n\n\n<li>Chiropractic<\/li>\n<\/ul>\n\n\n\n<p>Please note that the current Medicare reimbursement rate for the 97750 CPT code is between $31 and $48, depending on the MAC locality and medical facility.&nbsp;&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>What Performance Measurement Tests are Covered By <\/strong><strong>CPT Code 97750?&nbsp;&nbsp;<\/strong><\/h3>\n\n\n\n<p>The primary purpose of a physical performance test is to assess the patient\u2019s ability to handle day-to-day and work-related tasks after he has recovered from an injury, surgery, or illness that impacted his physical and cognitive functions. The 15-minute session is used to assess the patient\u2019s performance in the following areas:&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Activities of daily living (ADLs)<\/li>\n\n\n\n<li>Instrumental activities of daily living (IADLs)<\/li>\n\n\n\n<li>Occupational performance\u00a0<\/li>\n\n\n\n<li>Dexterity\u00a0<\/li>\n\n\n\n<li>Cognition<\/li>\n\n\n\n<li>Functional mobility\u00a0<\/li>\n\n\n\n<li>Equilibrium and balance\u00a0<\/li>\n\n\n\n<li>Aerobic capacity<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table><thead><tr><th class=\"has-text-align-center\" data-align=\"center\"><strong>Activities of Daily Living (ADLs)<\/strong><\/th><th class=\"has-text-align-center\" data-align=\"center\"><strong>Instrumental Activities of Daily Living (IADLs)<\/strong><\/th><\/tr><\/thead><tbody><tr><td class=\"has-text-align-center\" data-align=\"center\">Eating&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">Managing money&nbsp;<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Bathing&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">Managing health&nbsp;<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Toileting<\/td><td class=\"has-text-align-center\" data-align=\"center\">Managing household (cooking, laundry, child-rearing, etc.)<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Dressing<\/td><td class=\"has-text-align-center\" data-align=\"center\">Managing transportation&nbsp;<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Grooming<\/td><td class=\"has-text-align-center\" data-align=\"center\">Maintaining communication&nbsp;<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Mobility&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">Making complex decisions<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>What Should You Expect During a Functional Capacity Evaluation Session?<\/strong><\/h3>\n\n\n\n<p>A comprehensive functional capacity evaluation, reported by CPT code 97750, includes the following manual and equipment-based tests and measurements:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A 6-minute walk test\u00a0<\/li>\n\n\n\n<li>Manual muscle testing\u00a0<\/li>\n\n\n\n<li>Balance evaluation like the Timed Up and Go (TUG) test<\/li>\n\n\n\n<li>Evaluation of functional capacity<\/li>\n\n\n\n<li>Special musculoskeletal tests for one or more body region<\/li>\n\n\n\n<li>Range of Motion (ROM) testing<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Scenarios Where <\/strong><strong>CPT Code 97750<\/strong><strong> is Applicable<\/strong><\/h2>\n\n\n\n<p>So, now that you know that CPT code 97750 refers to a complete and objective physical performance test to evaluate the patient\u2019s functional and musculoskeletal capacity, let\u2019s try to understand why these tests are performed and in what instances you can bill this FCE CPT code. Look at the real-world scenarios below for details.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Pre-Employment Screening<\/strong><\/h3>\n\n\n\n<p>Employers across various industries may request a pre-employment physical performance test as part of medical screening from new or potential hires to assess if they are physically fit for what the job demands. For example, truck drivers, firefighters, law enforcement personnel, and even frontline healthcare workers like paramedics may be asked to undergo a comprehensive physical performance exam, denoted by CPT code 97750.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Workers\u2019 Compensation Cases<\/strong><\/h3>\n\n\n\n<p>A functional capacity evaluation is ordered after treatment\/surgery and recovery in <a href=\"https:\/\/medibillmd.com\/blog\/workers-compensation-billing-and-credentialing\/\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">Workers\u2019 Compensation<\/a> cases, where the patient was injured or fell ill because of his work, to gauge if the patient can return to work and perform the tasks assigned to him. The test results of FCEs also help identify the worker\u2019s functional limitations, paving the way for special considerations, e.g., assisted living (accommodation), reduced work hours, and restricted physical labor. After the evaluation, the provider can use the 97750 CPT code to bill the service under Workers\u2019 Compensation insurance.\u00a0<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Disability Assessments&nbsp;<\/strong><\/h3>\n\n\n\n<p>The U.S. federal government provides <a href=\"https:\/\/www.ssa.gov\/disability\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">Social Security Disability Insurance<\/a> (SSDI) or disability benefits to people who are unable to work and earn an income because of their disability. The monthly payments are deposited in the beneficiary\u2019s account. However, to claim this benefit, the person must submit objective data or reports on his disability. This is where disability evaluations come in. The detailed screening, reported by CPT code 97750, substantiates the patient\u2019s disability claim as several tests prove his functional decline and inability to perform efficiently at work.\u00a0<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Rehabilitation Progress Evaluation&nbsp;<\/strong><\/h3>\n\n\n\n<p>CPT code 97750 can also be used for performance testing conducted in physical rehabilitation centers. The provider performs a functional capacity evaluation to see if there are any improvements after the patient undergoes physical rehabilitation therapies. If the patient\u2019s natural functionality remains unrestored, the provider will adjust the treatment plan to enhance the effects of physical rehab therapies.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Other CPT Codes Related to 97750<\/strong><\/h2>\n\n\n\n<p>CPT code 97750 is not the only code that reports a specialized physical assessment performed on a patient. Some other CPT codes are also used for billing physical tests and measurements in an outpatient physical or occupational therapy center. Hence, they have come to be known as related codes.&nbsp;<\/p>\n\n\n\n<p>Before we dive into the descriptions of these related codes, please note that the Centers for Medicare and Medicaid Services (CMS) has strict rules for billing CPT code 97750 and its related formal testing codes. We will touch upon these do\u2019s and don\u2019ts later in the guide.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>CPT Code 95851<\/strong><\/h3>\n\n\n\n<p>A range of motion (ROM) is an equipment-based test that measures the degree of movement of a joint. A device called a goniometer measures the angle at a joint between 0 to 180 or 360 degrees, assessing the movement and flexibility of bones, joints, muscles, ligaments, and tendons. However, CPT code 95851 specifically reports a ROM test to measure the range of motion in one section of the spine or one extremity (excluding the hand). It is a separately billable code under the \u2018range of motion testing\u2019 code set.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>CPT Code 95852<\/strong><\/h3>\n\n\n\n<p>95852 is also a ROM testing code and bills the measurement of movement in the patient\u2019s hand. The provider uses a goniometer to see the range of motion in a hand that was previously injured or affected by disability. He may compare the findings of the other (normal functioning) hand with the injured one.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>CPT Code 97755<\/strong><\/h3>\n\n\n\n<p>CPT codes 97750 and 97755 are part of the same code range. However, code 97755 denotes a one-on-one assessment to measure the patient\u2019s degree of disability and decide which assistive technology will be the best compensation for the patient\u2019s lost function(s). Hence, CPT code 97755 is an assistive technology assessment and involves the preparation of a detailed report to document the test findings.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>CPT Code 96112<\/strong><\/h3>\n\n\n\n<p>Can you recall playing a game called \u2018Find The Odd One Out\u2019 in your childhood? It is a lot like that when we come to CPT code 96112. Although 96112 is a related code, it is unique from the other four formal testing codes because of the category it falls under, the age range of patients it targets, and the aspect of human care it tests. Basically, CPT code 96112 is used when the provider performs a series of tests (e.g., BOT-2) on a child to diagnose developmental problems and prepare a detailed report on the findings. The tests last an hour, and this code specifically reports the first hour of testing.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>97750 CPT Code &#8211; Reimbursement<\/strong><strong> Guidelines<\/strong><\/h2>\n\n\n\n<p><a href=\"https:\/\/www.beckersasc.com\/asc-coding-billing-and-collections\/which-physicians-have-the-most-claims-denied-resubmitted-a-specialty-breakdown.html\" rel=\"nofollow noopener\" target=\"_blank\">Survey results<\/a> obtained from over 17,461 clinicians representing more than 30 specialties across the nation\u2019s healthcare landscape have shown that Physical Medicine and Rehabilitation has one of the highest denial rates. Around 19% of the medical claims submitted by physical medicine and rehabilitation specialists are denied, even though the average denial rate across all specialties is between 5% and 10%.&nbsp;<\/p>\n\n\n\n<p>After looking at the grim stats above, how can you ensure a first-pass claim submission for your 97750 CPT code? The answer is simple &#8211; follow billing best practices to nip denials in the bud. Here are some carefully thought out, tried &amp; tested reimbursement guidelines for CPT code 97750 to help you collect better.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Ensure Coding Accuracy&nbsp;<\/strong><\/h3>\n\n\n\n<p>When billing a thorough physical performance test or functional capacity evaluation, you must ensure that you are using the correct FCE CPT code and it accurately captures a range of musculoskeletal, endurance, balance, and mobility assessments. Moreover, you must follow the insurance payer\u2019s specific coding guidelines, such as appending appropriate modifiers and unit-based billing, when reporting CPT code 97750 to avoid claim denials.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Maintain Complete Documentation<\/strong><\/h3>\n\n\n\n<p>Your supporting documents should prove the medical necessity of a physical performance test. For example, if you are filing a workers\u2019 compensation insurance claim, you must submit all the required documents to the payer with the 97750 claim form to explain that a complete physical performance test was necessary to prove that the patient has recovered from a work-related injury and can resume work on the natural level of his functionality.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Educate and Train Your Staff&nbsp;<\/strong><\/h3>\n\n\n\n<p>To secure a high and timely reimbursement for CPT code 97750, you must provide regular training to your staff on coding best practices and educate them on the updates in coding systems, government regulations, and payer policies. They should be familiar with all challenges that may arise when billing code 97750 and must know effective strategies to overcome them.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Confirm Direct Provider-Patient Contact&nbsp;<\/strong><\/h3>\n\n\n\n<p>Functional Capacity Evaluation CPT Code 97750 can only be reported for face-to-face testing in which the provider spends at least 15 minutes with the patient, evaluating his ability to perform various functions, such as balancing, walking, bending, communicating, holding, dodging, etc. So, before entering the code, you must check the physical therapy notes (clinical notes) to confirm if the patient received service directly from a qualified healthcare provider (therapist, chiropractor, or physical\/occupational therapy assistant) or if a telehealth service is wrongly being reported by CPT code 97750.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Bill in 15-Minute Increments&nbsp;<\/strong><\/h3>\n\n\n\n<p>97750 is a timed CPT code and is billed in 15-minute blocks. You must report 1 unit of CPT code 97750 when the performance test lasts up to 22 minutes. You can add more units depending on the total time the provider spends with the patient testing his functional capabilities. Refer to the table below for clarity.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table><thead><tr><th class=\"has-text-align-center\" data-align=\"center\"><strong>Billing Units\u00a0<\/strong><\/th><th class=\"has-text-align-center\" data-align=\"center\"><strong>Test Duration\u00a0<\/strong><\/th><th class=\"has-text-align-center\" data-align=\"center\"><strong>Details\u00a0<\/strong><\/th><\/tr><\/thead><tbody><tr><td class=\"has-text-align-center\" data-align=\"center\">1 unit&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">15 minutes&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">The provider-patient direct contact testing lasts at least 8 minutes and up to 22 minutes&nbsp;<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">2 units&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">30 minutes&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">The provider-patient direct contact testing lasts at least 23 minutes and up to 37 minutes&nbsp;<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">3 units&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">45 minutes&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">The provider-patient direct contact testing lasts at least 38 minutes and up to 52 minutes&nbsp;<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">4 units&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">60 minutes&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">The provider-patient direct contact testing lasts at least 53 minutes and up to 67 minutes&nbsp;<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">5 units&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">75 minutes&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">The provider-patient direct contact testing lasts at least 68 minutes and up to 82 minutes&nbsp;<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">6 units&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">90 minutes&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">The provider-patient direct contact testing lasts at least 83 minutes and up to 97 minutes&nbsp;<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">7 units&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">105 minutes&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">The provider-patient direct contact testing lasts at least 98 minutes and up to 112 minutes&nbsp;<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">8 units&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">120 minutes&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">The provider-patient direct contact testing lasts at least 113 minutes and up to 127 minutes&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Follow CMS\u2019 8-Minute Rule&nbsp;<\/strong><\/h3>\n\n\n\n<p>Medicare\u2019s 8-minute Rule, or the Rule of 8\u2019s, states that if you want to bill 1 unit of a physical therapy service, the provider should perform that service or procedure for at least 8 minutes. That\u2019s why the unit-based billing starts at 8 minutes and goes up to 127 minutes, depending on the total time spent with the patient. So, even if the physical performance test lasted less than 15 minutes but longer than 8, you can report 1 unit of CPT code 97750 to bill the service and collect reimbursement accordingly.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Don\u2019t Bill <\/strong><strong>97750 CPT Code<\/strong><strong> On the Same Day as An Initial Evaluation<\/strong><\/h3>\n\n\n\n<p>Another directive that Medicare has given in regard to billing the 97750 CPT code for FCE is that you cannot claim separate reimbursements if an initial therapy evaluation and a physical performance test were conducted on the same day. It is because, as per the Correct Coding Initiative (CCI) edits, the initial evaluation for physical therapy covers performance, ROM, and manual muscle tests, denoted by CPT codes 97750, 95851-95852, and 97755, respectively.&nbsp;&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Append Appropriate Physical Therapy Modifiers&nbsp;<\/strong><\/h3>\n\n\n\n<p>Modifiers are 2-digit alphanumerical, standardized codes used with CPT and Healthcare Common Procedure Coding System (HCPCS) codes to offer more explanation about the billable service, product, or procedure. For example, modifier 59 can be appended with CPT code 97750 if another service was performed on the same day, on the same patient, by the same provider, in the same outpatient physical therapy center, but was distinct and billed separately. Some other modifiers that you can append with code 97750 are:&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>GO &#8211; Service delivered at an outpatient occupational therapy center.<\/li>\n\n\n\n<li>GP &#8211; Service delivered at an outpatient physical therapy center.<\/li>\n\n\n\n<li>76 &#8211; The procedure was repeated by the same physician.\u00a0<\/li>\n\n\n\n<li>77 &#8211; The procedure was repeated by another physician.<\/li>\n\n\n\n<li>KX &#8211; The specific therapy or service was medically necessary and exceeds the annual threshold amounts set by Medicare (<a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/therapy-services\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">$2,330<\/a> for CY 2024).<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Final Word&nbsp;<\/strong><\/h2>\n\n\n\n<p>CPT code 97750 is commonly reported by physical, occupational, and rehabilitation therapists to indicate an objective yet detailed physical performance test that is billed in 15-minute increments and assesses a patient\u2019s musculoskeletal and functional capacities. The test may be performed for several reasons. For example, to chart the patient\u2019s recovery after a work-related injury, surgery, or illness that impacted his body\u2019s normal functioning.&nbsp;<\/p>\n\n\n\n<p>Today, we covered the 97750 CPT code\u2019s description, correct application, related codes, and reimbursement guidelines to help you master coding accuracy for physical therapy.&nbsp;<\/p>\n\n\n\n<p>However, if you have reached a state of \u201cinformation overload, situation lost control\u201d, send an SOS to us at MediBillMD. Our <a href=\"https:\/\/medibillmd.com\/specialties\/physical-therapy-billing-services\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>physical therapy billing services<\/strong><\/a> include precise CPT coding and detailed documentation, helping you achieve a 97% claim first-pass ratio.\u00a0<\/p>\n\n\n\n<p class=\"has-text-align-center has-text-color has-link-color has-large-font-size wp-elements-abb47e80fabc22046fdcb7a89e86f1a7\" style=\"color:#045cb4;margin-bottom:var(--wp--preset--spacing--30)\"><strong>Frequently Asked Questions<\/strong><\/p>\n\n\n<div class=\"wp-block-uagb-faq uagb-faq__outer-wrap uagb-block-443b43bb uagb-faq-icon-row-reverse uagb-faq-layout-accordion uagb-faq-expand-first-true uagb-faq-inactive-other-true uagb-faq__wrap uagb-buttons-layout-wrap uagb-faq-equal-height     \" data-faqtoggle=\"true\" role=\"tablist\"><script type=\"application\/ld+json\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@type\":\"FAQPage\",\"@id\":\"https:\\\/\\\/medibillmd.com\\\/blog\\\/cpt-code-97750\\\/\",\"mainEntity\":[{\"@type\":\"Question\",\"name\":\"<strong>What is the reimbursement rate for the 97750 CPT code?<\\\/strong>\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"The reimbursement rate for CPT code 97750 varies based on the type of insurance provider (government or private) and the physician fee schedule that is mentioned in the contract and agreed upon by the healthcare provider and insurance payer. However, the current \\u00b7 \\u00a0 \\u00a0 \\u00a0 \\u00a0 97750 CPT code reimbursement rate set by Medicare is between $31 and $48, depending on the MAC locality and medical facility.\\u00a0\"}},{\"@type\":\"Question\",\"name\":\"<strong>Who can bill a CPT code 97750?<\\\/strong>\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Physical therapists, occupational therapists, chiropractors, and physical rehabilitation therapists can bill the 97750 CPT code for a physical performance test reimbursement.\\u00a0\"}},{\"@type\":\"Question\",\"name\":\"<strong>Is CPT 97750 a timed code?<\\\/strong>\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Yes. 97750 is a timed CPT code and should be reported in 15-minute increments. You can report 1 unit of 97750 for the first 15 minutes and 3 units if the tests exceed up to 45 minutes of direct provider-patient time.\"}},{\"@type\":\"Question\",\"name\":\"<strong>Can 97750 be billed with 97140?<\\\/strong>\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Yes. Chiropractors and physical\\\/occupational\\\/rehabilitation therapists can use CPT codes 97750 and 97140 on the same day. Both are separately billable services with distinct purposes. However, you should use modifier 59 to indicate that these \\u201cservices performed on the same day are distinct and separate\\u201d to avoid claim duplication and denial. Note that CPT code 97140 reports a manual therapy technique lasting 15 minutes, e.g., a connective tissue massage, manual traction, or joint manipulation and mobilization.\\u00a0\\u00a0\"}}]}<\/script><div class=\"wp-block-uagb-faq-child uagb-faq-child__outer-wrap uagb-faq-item uagb-block-e15bfb78 \" role=\"tab\" tabindex=\"0\"><div class=\"uagb-faq-questions-button uagb-faq-questions\"><span class=\"uagb-question\"><strong>What is the reimbursement rate for the 97750 CPT code?<\/strong><\/span><\/div><div class=\"uagb-faq-content\"><p>The reimbursement rate for CPT code 97750 varies based on the type of insurance provider (government or private) and the physician fee schedule that is mentioned in the contract and agreed upon by the healthcare provider and insurance payer. However, the current \u00b7 \u00a0 \u00a0 \u00a0 \u00a0 97750 CPT code reimbursement rate set by Medicare is between $31 and $48, depending on the MAC locality and medical facility.\u00a0<\/p><\/div><\/div><div class=\"wp-block-uagb-faq-child uagb-faq-child__outer-wrap uagb-faq-item uagb-block-996014c8 \" role=\"tab\" tabindex=\"0\"><div class=\"uagb-faq-questions-button uagb-faq-questions\"><span class=\"uagb-question\"><strong>Who can bill a CPT code 97750?<\/strong><\/span><\/div><div class=\"uagb-faq-content\"><p>Physical therapists, occupational therapists, chiropractors, and physical rehabilitation therapists can bill the 97750 CPT code for a physical performance test reimbursement.\u00a0<\/p><\/div><\/div><div class=\"wp-block-uagb-faq-child uagb-faq-child__outer-wrap uagb-faq-item uagb-block-eeecc797 \" role=\"tab\" tabindex=\"0\"><div class=\"uagb-faq-questions-button uagb-faq-questions\"><span class=\"uagb-question\"><strong>Is CPT 97750 a timed code?<\/strong><\/span><\/div><div class=\"uagb-faq-content\"><p>Yes. 97750 is a timed CPT code and should be reported in 15-minute increments. You can report 1 unit of 97750 for the first 15 minutes and 3 units if the tests exceed up to 45 minutes of direct provider-patient time.<\/p><\/div><\/div><div class=\"wp-block-uagb-faq-child uagb-faq-child__outer-wrap uagb-faq-item uagb-block-ba1ea06c \" role=\"tab\" tabindex=\"0\"><div class=\"uagb-faq-questions-button uagb-faq-questions\"><span class=\"uagb-question\"><strong>Can 97750 be billed with 97140?<\/strong><\/span><\/div><div class=\"uagb-faq-content\"><p>Yes. Chiropractors and physical\/occupational\/rehabilitation therapists can use CPT codes 97750 and 97140 on the same day. Both are separately billable services with distinct purposes. However, you should use modifier 59 to indicate that these \u201cservices performed on the same day are distinct and separate\u201d to avoid claim duplication and denial. Note that CPT code 97140 reports a manual therapy technique lasting 15 minutes, e.g., a connective tissue massage, manual traction, or joint manipulation and mobilization.\u00a0\u00a0<\/p><\/div><\/div><\/div>\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Just another day, just another code to demystify! Such is the life when it comes to medical billing. But with [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":2230,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","content-type":"","_uag_custom_page_level_css":"","site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[10],"tags":[],"class_list":["post-2229","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cpt-codes"],"uagb_featured_image_src":{"full":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2024\/12\/Ultimate-Guide-to-97750.webp",1200,720,false],"thumbnail":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2024\/12\/Ultimate-Guide-to-97750-150x150.webp",150,150,true],"medium":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2024\/12\/Ultimate-Guide-to-97750-300x180.webp",300,180,true],"medium_large":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2024\/12\/Ultimate-Guide-to-97750-768x461.webp",768,461,true],"large":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2024\/12\/Ultimate-Guide-to-97750-1024x614.webp",1024,614,true],"1536x1536":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2024\/12\/Ultimate-Guide-to-97750.webp",1200,720,false],"2048x2048":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2024\/12\/Ultimate-Guide-to-97750.webp",1200,720,false]},"uagb_author_info":{"display_name":"Fred Allen","author_link":"https:\/\/medibillmd.com\/blog\/author\/fred-allen\/"},"uagb_comment_info":0,"uagb_excerpt":"Just another day, just another code to demystify! Such is the life when it comes to medical billing. But with [&hellip;]","_links":{"self":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts\/2229","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/comments?post=2229"}],"version-history":[{"count":0,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts\/2229\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/media\/2230"}],"wp:attachment":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/media?parent=2229"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/categories?post=2229"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/tags?post=2229"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}